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    SymptomsCausesPrevalenceFluoride SourcesTreatmentFluoride-free productsBioHAP instead of fluorideClinical Study

    ▲ Limeback, H., Enax, J. & Meyer, F. (2021): Biomimetic hydroxyapatite and caries prevention: a systematic review and meta-analysis. Can J Dent Hyg.; 55(3):148–159.

    A girl in a blue-and-white striped top smiles into the camera; white spots are visible on her front teeth, which are signs of dental fluorosis, a tooth enamel defect caused by excessive fluoride intake.A girl in a blue-and-white striped top smiles into the camera; white spots are visible on her front teeth, which are signs of dental fluorosis, a tooth enamel defect caused by excessive fluoride intake.

    Dental Fluorosis – Symptoms, Causes, and Treatment

    Where do the white spots on teeth actually come from?

    KAREX Toothpaste with BioHAP instead of fluoride

    Almost one in four children suffers from dental fluorosis ▲. This refers to chalky-white enamel spots on the teeth, which often appear on the front central teeth. They are caused by a disruption of mineralization during tooth development, leading to enamel spots and even enamel defects.

    Dental Fluorosis SymptomsDental Fluorosis Symptoms: White Spots and Tooth Discoloration

    Dental fluorosis manifests relatively simply, as already described, through white spots primarily on the front incisors.

    Close-up of a smiling girl's mouth; the focus is on the front teeth, which show fluorosis in the form of white spots on the teeth.

    FluorosisFluorosis: Causes of Fluorosis

    Fluorosis is caused by the intake of too much fluoride. The high fluoride intake during the maturation phase of the teeth sensitively alters the enamel surface.

    Swipe for more facts about the causes of fluorosis.

    A girl looks questioningly into the camera and holds a toothbrush in her hand, as a symbol of uncertainty about the use of fluoride in childhood and the risk of dental fluorosis.

    Caution Fluoride!

    Between the ages of 1 and 7, too much fluoride can inhibit the healthy development of tooth enamel and lead to dental fluorosis.

    Eine orangene Zahnbürste hat einen Streifen Zahnpasta auf einem hellen, glatten Untergrund verstrichen; als Sinnbild dafür, dass nicht nur Zahnpasta eine Fluorid-Quelle darstellt

    How Does Fluoride Overdose Occur?

    Fluoride tablets, fluoride-containing toothpaste, and fluoride salt in food can lead to an overdose in children.

    A small boy in a dark blue sweater brushes his teeth, as a symbol of the fact that especially young children who still have baby teeth are susceptible to excessive fluoride intake.

    Sensitive Phases

    Children between the ages of 2 and 5 are particularly sensitive to fluoride overdose.

    Effects of Fluoride Overdose

    High fluoride intake can sensitively alter the enamel surface, make it more porous, and cause discoloration.

    A girl in a yellow top brushes her teeth with a toothbrush; a lot of foam has formed as a symbol of the fact that toothpaste is frequently swallowed by children.

    Why Are Children Susceptible?

    Due to their low body weight, children are more susceptible to fluoride overdose and often swallow toothpaste.

    A tube of KINDER KAREX Toothpaste and a tube of JUNIOR KAREX Toothpaste stand on a washstand in the bathroom; as a symbol that KAREX with BioHAP instead of fluoride can reduce the risk of developing fluorosis.

    Fluoride Source Is Often Difficult to Trace

    Many products contain fluoride, which makes it difficult to determine the actual amount absorbed.

    Replacing fluoride toothpaste with KAREX with BioHAP instead of fluoride already reduces one fluoride source without any loss of cavity protection.

    KAREX products without fluoride with BioHAP

    Dental Fluorosis in the PopulationDental Fluorosis in the Population: Dental fluorosis is widespread among both children and adults.

    Dental fluorosis: chalky-white enamel spots on the teeth

    Approximately one quarter of the population suffers from dental fluorosis due to excessive fluoride intake during childhood.

    Visible damage can be improved through elaborate measures, but never completely removed — meaning the fluorosis remains. Depending on the severity, it can be aesthetically bothersome for those affected, but can also have negative effects on the health of the tooth if the resistance of the tooth surface is compromised.

    Once damage to the tooth enamel has occurred, covering it up is complex and costly — which is why prevention is the best way to avoid dental fluorosis.

    Four white fluoride tablets and coarse fluoridated salt on a light, smooth surface as a symbol of the question "Where is fluoride found?"

    Fluoride sourcesFluoride sources: Where exactly is fluoride found?

    When parents hear (or read) "fluoride," they quickly think of fluoride tablets — and of course of toothpaste (our KAREX is made with BioHAP instead of fluoride). But there are many other sources of fluoride in everyday life.

    Coarse fluoridated table salt on a light, smooth surface as a symbol of salt as a source of fluoride

    Table salt

    Many households use fluoridated salt when cooking and baking — this means fluoride can quickly be overdosed.

    Even the Consumer Advice Center recommends: "If you use fluoridated salt, you should avoid additional fluoride supplements (dietary supplements or medications)."♢

    Small dried fish, walnuts, and salt on a light, smooth surface as a symbol of which foods contain fluoride

    Foods

    Some foods contain notable amounts of fluoride — these include fish, e.g. herring, bloater (0.36 mg/100 g), or sardines, seafood, and black tea.

    Fluoride is also found in grains, liver, and meat, as well as in soybeans (0.36 mg/100 g) and walnuts (0.7 mg/100 g).

    The highest amounts of fluoride, however, are found in fluoridated table salt (31 mg/100 g) as well as in drinking water and mineral water.

    Six white fluoride tablets on a light, smooth surface as a symbol of the fact that children frequently receive fluoride tablets and their fluoride needs are therefore already met

    Fluoride tablets

    To prevent cavities, babies and toddlers are frequently prescribed fluoride tablets, particularly in areas with low fluoride levels in drinking water.

    For healthy bone growth, pediatricians also like to prescribe Vitamin D tablets, often as a combined fluoride supplement.

    When using fluoride tablets, dental professional associations as well as pediatricians also recommend brushing with a fluoride-free toothpaste.

    A toothbrush and a pea lie on a light, smooth surface as a symbol of the fact that toothpaste containing fluoride should only be used in pea-sized or rice-grain-sized amounts in order to prevent fluoride overdose.

    Toothpaste

    The addition of fluoride to toothpastes is a subject of controversial debate, especially when it comes to products for children under 6 years of age. The main problem: dosage.

    Fluoridated toothpaste for children up to 6 years that contains 1,000 ppm fluoride or more should only be applied in a “pea-sized” amount on the toothbrush; for children under 2 years, the amount should be only “rice-grain-sized.”

    However, in everyday use, the legally mandated limitation that must be indicated on toothpaste tubes is, on average, exceeded by a factor of five to seven.△

    Fluorosis TreatmentFluorosis Treatment: Stop excessive fluoride intake immediately

    A mother and her toddler look curiously at a running faucet, while the toddler holds a children's toothbrush with toothpaste toward the faucet; as a symbol of preventing dental fluorosis with the help of fluoride-free toothpaste.

    When it comes to dental fluorosis, it is crucial to stop excessive fluoride intake immediately. In mild cases, further treatment is not always necessary; however, the damage — such as white spots on the teeth — is irreversible without intensive dental care. Treatment options include polishing pastes, veneers, composite fillings, or bleaching, but individual consultation with a dentist is advisable.

    Prevention is the best approach, as treating spots on the teeth is often complex and costly.

    Fluoride-free ProductsFluoride-free Products: Prevent dental fluorosis in children before it even starts

    Dental care with the tooth-related active ingredient BioHAP

    BioHAP instead of FluorideBioHAP instead of Fluoride: KAREX, the children's toothpaste without fluoride

    The KAREX children's toothpaste with the tooth-related active ingredient BioHAP, also known as biomimetic hydroxyapatite, offers a fluoride-free solution for dental care in children.

    More about the active ingredient hydroxyapatite?

    BioHAP is just as effective as fluoride in cavity prevention

    • Logos of the Max Planck Society, the Fraunhofer Institute, the Public Health Department of the City of Braunschweig, and Charité – Universitätsmedizin Berlin are arranged on a light blue background, symbolizing some of the research institutions that have published studies on Hydroxyapatite and BioHAP in oral care.

      Cavity protection proven by studies

      Numerous scientific publications confirm the effect of Hydroxyapatite in oral care. BioHAP is at least as effective as fluoride in cavity prevention.

      Learn more
    • Further studies & research findings

      Discover all studies

    GuideGuide: Recommended for you

    • A boy in a yellow T-shirt has his mouth wide open and shows his teeth as a symbol of chalky teeth (molar incisor hypomineralization) in children

      Chalk teeth: A new challenge for parents and dentists

      Many parents and dentists are facing a new challenge: chalk teeth. Around 30% of 12-year-olds suffer from molar incisor hypomineralization (MIH). But what exactly are chalky teeth? Find out more and protect your child’s teeth!

      Chalk teeth
    • A mother is brushing her toddler’s teeth with a toothpaste that contains BioHAP instead of fluoride, symbolizing the prevention of cavities in children

      Cavities in children: What you need to know!

      Cavities in your child? Find out how you can prevent them and keep your child’s teeth healthy. Discover the best tips now!

      Cavities in children
    • A young girl with reddish-blonde hair is standing in the bathroom brushing her teeth with a toothbrush, symbolizing proper dental care during tooth transition in children

      Tooth transition in children: How to support your child from baby teeth to permanent teeth

      Help your child during tooth transition and find out how you can optimally support this important process. Discover tips and tricks for a smooth tooth transition now!

    BioHAP benefitsBioHAP benefits: What exactly is BioHAP?

    KAREX – consciously with BioHAP instead of fluoride

    BioHAP is hydroxyapatite – the substance our teeth are made of. But BioHAP also stands for effective cavity protection without risk: the alternative for children and for everyone who does not want fluoride in their toothpaste.

    Learn more now
    • Tooth discoloration: usually chalky-white — dental professionals therefore refer to them as "white spots."

    • Brown discoloration (rare): Often only a few teeth are affected; in severe cases, the majority of teeth show discoloration.

    • Mild forms of dental fluorosis: lead to small white enamel spots on the teeth; in cases of severe overdose, enamel defects or even enamel breakdown can occur.

    • It comes down to the dosage.

      The German Federal Institute for Risk Assessment recommends using only one fluoride source in the household in order to minimize the risk of dental fluorosis. Dosage recommendations for fluoride toothpaste are important; however, it is unrealistic to expect children to brush their teeth with a rice-grain-sized amount. It is strongly advised against using fluoride tablets and fluoride-containing toothpaste at the same time.

    • KAREX children's toothpaste with BioHAP: Suitable for all age groups for cavity prevention.

    • Safe to swallow: No worries if your child swallows toothpaste, as BioHAP dissolves in the stomach.

    • Clinically proven efficacy – BioHAP works effectively against cavities

    • Free shipping from €15

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              • Zwei Tuben KINDER KAREX Zahnpasta, Aufschrift: „Zahnpasta mit BioHAP ohne Fluorid. Biomimetischer Hydroxylapatit“.

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                Tooth transition in children